Pragna Rao

The Global Burden of Disease warns that among women across the world, including India, stroke and ischemic heart disease are the major causes of death. Yet, at a tertiary care hospital in Hyderabad, India, approximately 61% of the women patients were found to have low-to-medium level of medication adherence for the secondary prevention of cardiovascular disease (CVDs). This is the finding of a study entitled “Medication adherence and its determinants among women of cardiovascular disease of tertiary care hospital, Hyderabad,” which was published in this journal. The authors felt that there was a paucity of studies, specifically among women, to understand the interplay of various determinants influencing medication adherence. Hence, this hospital-based study was taken up, which used the Morisky medication adherence scale (MMAS-4) to estimate the level of medication adherence. A considerable percentage (90%) of the women included in the study possessed educational qualifications which were less than a college degree, and over 90% were unemployed or poorly skilled. Economically, 57% of the women belonged to the upper and upper middle class. Among this population, prevalence of medication adherence among women afflicted with CVDs using MMAS-4 was found to be high among 39%, medium in 51%, and low in 10% of the study sample. The reasons given for unsatisfactory compliance were forgetfulness (11%), poverty (9.1%), irregular supply of drugs (18%), and limited supply among 7.4% of the women patients. Socioeconomic determinants such as poverty, unemployment, illiteracy, limited supply of drugs, and high-cost of medicines were the significant reasons for low-medication adherence. Patient-related determinants such as the unwillingness of patients to take medicines, especially for a long duration, forgetfulness, and the reluctance to continue medications once the symptoms subsided were also significant factors. Of major concern was the fact that irregular supply of drugs at the government center became a significant reason for nonadherence. The study concludes that better medication adherence needs to be addressed by targeting the common determinants such as forgetfulness which can be reduced by putting reminders in mobile phones, creating health education about the importance of intake of drugs, thereby preventing complications with regular follow-up, and physician’s taking up the responsibility to effectively communicate the lifelong need for medications in addition to healthy lifestyle modifications Although the reasons for nonadherence are multifactorial, studies conducted among the Indian population (including both males and females) have blamed the patients’ lack of awareness about the disease and its complications. The second commonly cited reason for nonadherence is “forgetfulness.” To extend the same simplistic arguments among women patients would be committing both social and medical injustice. An earlier study by Gupta et al examined the socioeconomic barriers for low adherence to antihypertensive medication among women in India. Poor access to healthcare, out-of-pocket payments, borrowing money, lack of insurance, and cost of medicines were cited as major deterrents to medication adherence.[1] The problem may lie even deeper than that. Among women in South Asia, gender-based discrimination can cause adverse health outcomes. Beginning from food allocation, and being unable to access healthcare services and finances to pay for their treatment, women face odds in society. Saikia et al[2] argue that in poor families, health-related expenditure usually leads to compromising the health needs of female family members. Even in families where finance is not a concern, women have less power to demand that their needs be taken care of, due to lack of income-earning means, lack of support from the community, and social norms and perceptions. Thus, the gender differential in healthcare expenditure in India is perhaps the result of powerful synergies between socioeconomic status and a male-dominated society. Medication nonadherence could be a silent, unspoken result of these factors. Any kind of gender discrimination is a cause of concern, irrespective of the disease. An economic discussion paper written by authors of the Indian Statistical Institute, New Delhi,[3] indicated that gender discrimination accounts for 73% of the gender difference in cumulative total expenditure. Of this, 64% of the difference is on account of gender discrimination in cumulative medical expenditure. When such is the case, medication nonadherence is a natural fallout. Most of the differences emerge from expenditures before the patient even reaches the tertiary care hospital. Medication nonadherence will increase inequalities in health outcomes between the genders, and also impose a larger economic impact by way of healthy life years lost to disease. Besides, children in families, particularly nuclear families, get affected when a female caregiver, like a mother, is not healthy. This calls for systemic societal and governmental action to introduce gender-inclusive health education in India, emphasizing the significance of NCDs and the treatment associated with them. However, the larger need remains, which involves empowering women by engaging them in economic activities to reduce gender-based discrimination in healthcare. Possible gender-based problems can be addressed by more innovative, informed, and gender-sensitive planning, including targeted education and culturally sensitive communication campaigns. Teleconsultations with women healthcare providers might play an important role in boosting medication adherence. Better medication adherence, therefore, goes beyond just obeying the doctor’s prescription. Its ramifications are both social and economic, and they play a vital role in supporting a healthy society. Publication Date: 23 December 2020 (online) © 2020. Women in...

Thiamine deficiency, if detected early in infancy, can be treated with thiamine supplementation and can prevent seizures, other disabilities and death. The dried blood spot (DBS) sampling technique is an attractive sample collection technique for infants. The present study reports the development and validation of a highly sensitive and precise method for quantification of thiamine diphosphate from DBS. The method utilizes full‐spot analysis of a volumetrically deposited 40 μl DBS. The analyte was extracted from the DBS using 50% methanol and then derivatized using potassium ferricyanide to thiochrome. Separation was achieved with the help of an Inertsil ODS C₁₈ column (5.0 μm, 250 × 4.6 mm) using 150 mm phosphate buffer pH 7–acetonitrile (90:10, % v/v) as the mobile phase. The use of a fluorimetric detector gave a good response to the thiochrome derivative offering good sensitivity for the method. The excitation and emission wavelengths were 367 and 435 nm, respectively. The limit of detection and lower limit of quantification were 5 and 10 ng/ml, respectively. Linearity was demonstrated from 10 to 1000 ng/ml, and precision (CV) was 80%. Bland–Altman analysis of DBS sampling vs. whole blood demonstrated a mean bias of only 1.16 ng/ml, with a majority of the 60 investigated patient samples lying within 7.2% of the corresponding concentration measured in blood, thereby meeting the clinical desirable biological specification criterion and showing that the two methods are comparable.

25-Hydroxyvitamin D (25-(OH)D) deficiency is recently been described as one of the multiple factors responsible for pediatric seizures. 25-Hydroxyvitamin D3 and 25-Hydroxyvitamin D2 are the well-known markers to determine Vitamin D status. In this work we report the development of a sensitive and cost effective HPLC technique for the quantification of the vitamin D metabolites from dried blood spot samples (DBS). The metabolites were extracted using acetonitrile–methanol–0.1% formic acid (60 : 20 : 20 (v/v)) and analyzed on an Acclaim C18 column (150 × 4.6 mm i.d., 3 µm) at a flow rate of 1 mL/min. The method was linear in the range of 10–80 ng/mL. Limit of detection and limit of quantification (LOQ) of the method were 5 and 10 ng/mL respectively. Extensive stability studies demonstrated the analytes to be stable in stock and matrix with a percent change within the acceptable range of ±15%. Comparison of the newly developed HPLC-DBS method with the reported LC-MS-DBS and electrochemiluminescence immunoassay (ECLIA) methods followed by Bland–Altman analysis demonstrated a bias of 0.08 and −0.14, respectively proving the methods are comparable. Application of the developed method to a pediatric seizure cohort depicted 46.6% of cases as deficient and 26.6% as insufficient for 25-(OH)D. Among deficient cases 8 samples were below 10 ng/mL and exact amount was not calculated since these were below the LOQ levels. The mean ± standard deviation (S.D.) in the remaining 6 deficient cases was 13.22 ± 2.80 ng/mL. The levels in healthy infants were 33.9 ± 6.11 ng/mL. The method can be used routinely for assessing 25-(OH)D deficiency in newborn.

Association of angiogenic cytokines (VEGF-A and VEGF-C) and clinical characteristic in women with unexplained recurrent miscarriage

We aimed to scrutinize the extent to which single amino acid substitutions in the MTHFR and FVL genes affect the risk of GDM in pregnant women of South Indian descendant. This case-control study was implemented once the ethical approval has been obtained. Overall 237 women were recruited in this study: 137 had been diagnosed with GDM and the remaining 100 women were used as normal controls or non-GDM. The diagnosis of GDM was confirmed with biochemical analysis i.e., GCT and OGTT tests. Five milliliters of peripheral blood was collected and used for biochemical and molecular analyses. DNA was isolated and genotyping for MTHFR (C677T) and FVL (G1691A) mutations was performed using PCR-RFLP. FVL (G1691A) locus was not polymorphic in the investigated sample. There was no significant difference in the allele and genotype frequencies of C677T polymorphism between GDM and non-GDM women (p=0.8892)

Biochemical and histopathological analyses are commonly used objective parameters in research and clinical fields to assess the healing status of burn wounds. In this study, the effect of newer intermittent negative‐pressure wound therapy in combination with moist environment [limited access dressing (LAD)] on burn wound healing is studied. Various biochemical parameters like hydroxyproline, hexosamine and total protein, and antioxidants like reduced glutathione (GSH), glutathione peroxidase (GPx) and oxidative biomarker malondialdhyde (MDA) were measured in the granulation tissue. Histopathologically, necrotic tissue, amount of inflammatory infiltrate, angiogenesis and extracellular matrix deposition (ECM) were studied to determine wound healing. A total of 55 patients were divided into two groups as follows: LAD group (n = 28) and conventional dressing group (n = 27). Patients treated with LAD have shown significant increase in the mean levels of (±SD) hydroxyproline (75·2 ± 26·30 versus 27·8 ± 15·5; P = 0·010), hexosamine (9·0 ± 1·99 versus 8·0 ± 1·18; P = 0·038), total protein (15·6 ± 8·23 versus 10·26 ± 4·94; P = 0·003), GSH (7·40 ± 1·91 versus 5·1 ± 1·28; P = 0·037), GPx (112·6 ± 46·4 versus 92 ± 32·4; P = 0·016), and decrease in MDA (6·5 ± 2·24 versus 1 0·6 ± 3·8; P = 0·002). Histopathologically, between LAD and conventional dressing groups, there was a significant difference after 10 days of treatment (mean±SE) in necrotic tissue of (LAD versus conventional dressing groups = 10 ± 1·8 versus 11·9 ± 2·6; P = 0·033), inflammatory cells (8·4 ± 1·9 versus 13 ± 3·46; P = 0·021), new blood vessels (12·5 ± 2·87 versus 9·4 ± 1·7; P = 0·047), ECM deposit (12·9 ± 2·41 versus 9·68 ± 1·3; P = 0·018) and showed comparatively fewer inflammatory cells, increased and well‐organised extracellular matrix deposit, more angiogenesis in LAD group as compared with that in conventional dressing group. To conclude, LAD exerts its beneficial effects on wound healing by reducing oxidative stress, decreasing necrotic tissue and amount of inflammatory infiltrate, and increasing ECM deposition and angiogenesis.

The rs7903146 and rs13266634 polymorphisms in the TCF7L2 and SLC30A8 genes, respectively, have been reported to be associated with type 2 diabetes. However, little is known about the association of these polymorphisms with post-transplant diabetes mellitus (PTDM). To study this linkage, we determined a distribution of allele and genotype frequencies in Asian Indians. 42 PTDM and 98 non-PTDM subjects were recruited. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis was performed to detect for rs7903146 and rs13266634 polymorphisms. The clinical details and statistical analysis for PTDM and non-PTDM subjects were recorded. Our results observed higher frequencies of the minor alleles in rs7903146 and rs13266634 polymorphisms in the PTDM group compared to the non-PTDM subjects. The allele frequencies also found to be significantly associated with PTDM (rs7903146: T vs C: OR-2.6; (95%CI: 1.2-5.6); p = 0.01; rs13266634: T vs C: OR-2.0; (95%CI: 1.1-3.4); p = 0.01). These findings suggest that rs7903146 and rs13266634 polymorphisms are associated with PTDM in the Asian Indian population despite a relatively small study group.